Dual therapy for Helicobacter pylori infection

BackgroundThe amoxicillin dose used in dual therapy to eradicate Helicobacter pylori varies across studies and the optimal amoxicillin dose for vonoprazan‐based dual therapies remains unclear. We aimed to investigate the efficacy and safety of low‐ and high‐dose amoxicillin in vonoprazan–amoxicillin dual therapy.Materials and MethodsA comprehensive systematic review was conducted by searching databases from inception to October 2023. All trials that evaluated the effectiveness and safety of vonoprazan–amoxicillin dual therapy for eradicating H. pylori were included. Pooled eradication rate, incidence of adverse events, relative risks, and 95% confidence intervals are presented.ResultsEighteen studies with 12 low‐dose amoxicillin (VLA) and 13 high‐dose amoxicillin (VHA) arms were included. The pooled eradication rates were 82.4% and 86.8% for VLA therapy, and 86.0% and 90.9% for VHA therapy by the intention‐to‐treat and per‐protocol analyses, respectively. In the subgroup analysis stratified by duration, the eradication rates achieved in 7 days, 10 days, and 14 days treatments with VLA and VHA dual therapies were 80.8%, 84.2%, 83.1%, and 67.3%, 88.8%, 87.5%, respectively. In the four randomized controlled trials that directly compared VLA and VHA dual therapies, the efficacy was not statistically different in the intention‐to‐treat (76.9% vs 81.4%, p = 0.337) and per‐protocol (81.6% vs 84.0%, p = 0.166) analyses. Additionally, the incidence of adverse events (p = 0.965) and compliance (p = 0.994) were similar in both groups.ConclusionVLA therapy demonstrated comparable efficacy and safety to VHA therapy, along with regional differences. An appropriately extended treatment duration may be critical for therapeutic optimization of vonoprazan–amoxicillin treatment.

Section: Discussionmentioning

confidence: 99%

Low‐dose or high‐dose amoxicillin in vonoprazan‐based dual therapy for Helicobacter pylori eradication? A systematic review and meta‐analysis

Ju,

Kong,

et al. 2024

“…In areas of low (<15%) C resistance and patients with no history of exposure to macrolides: C-containing TT 14 Toronto Consensus 10 In areas of high (>15%) C resistance: BQT or CQT HDDT, characterized by high-dose acid suppression in combination with amoxicillin (≥3000 mg daily). 24 Back in 1995, PPIs combined with amoxicillin had achieved reliable efficacy against H. pylori. 25…”

Section: -14mentioning

confidence: 99%

“…Amoxicillin, in turn, assumes a bactericidal role by inhibiting the synthesis of bacterial cell walls. 24,[76][77][78] Therefore, the use of acid suppressors plays a pivotal role in H. pylori eradication.…”

Section: Appli C Ati On Of Acid Suppre Ssor Smentioning

confidence: 99%

“…HDDT, characterized by high‐dose acid suppression in combination with amoxicillin (≥3000 mg daily) 24 . Back in 1995, PPIs combined with amoxicillin had achieved reliable efficacy against H .…”

Section: Commonly Used Treatment Regimens Of H Pylorimentioning

confidence: 99%

“…pylori enters a state of active replication, leading to a rapid increase in the concentration of amoxicillin within the stomach. Amoxicillin, in turn, assumes a bactericidal role by inhibiting the synthesis of bacterial cell walls 24,76–78 . Therefore, the use of acid suppressors plays a pivotal role in H .…”

Section: Application Of Acid Suppressorsmentioning

confidence: 99%

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Clarifying varied Helicobacter pylori eradication therapies: A comprehensive review

Wu,

Duan,

Kong

et al. 2024

Self Cite

Current global variations exist in Helicobacter pylori (H. pylori) eradication regimens. Triple therapy (TT), bismuth quadruple therapy (BQT), and high‐dose dual therapy (HDDT) currently represent the predominant regimens. These regimens diverge in terms of treatment duration, the utilization of susceptibility testing, acid‐inhibiting drug administration, and patient education. We conducted a comprehensive systematic literature review on these H. pylori treatment regimens. Our review aims to provide standardized treatment recommendations for H. pylori, reducing the risk of amalgamating findings from diverse eradication regimens. Recent research suggests that the optimal treatment duration for TT and BQT may be 14 and 10 days, respectively. Selecting the appropriate treatment duration for HDDT should rely on regional research evidence, and 14 days may be the optimal duration. The incorporation of susceptibility testing in TT is of paramount importance. In the case of BQT, the absence of susceptibility testing may be considered as an option, contingent upon cost and availability, and should be determined based on local antibiotic resistance patterns and the efficacy of empirical regimens. The type and dosage of acid‐inhibiting drug would affect the efficacy of these regimens. Acid‐inhibiting drugs should be selected and applied reasonably according to the population and therapies. Adequate patient education plays a pivotal role in the eradication of H. pylori. In regions with accessible local research evidence, the 10‐day empirical BQT regimen may be considered a preferred choice for H. pylori eradication.

Fourteen‐Day Tegoprazan–Amoxicillin Dual Therapy as the First‐Line Treatment of Helicobacter pylori Infection (SHARE2301): A Multicenter, Noninferiority, Randomized Clinical Trial

Kong,

Mirza,

Zhang

et al. 2024

Self Cite

BackgroundPotassium‐competitive acid blockers have demonstrated enormous potential in the eradication treatment of Helicobacter pylori infection, with tegoprazan being one of the representatives. The available data on the safety and efficacy of tegoprazan in dual therapy are limited.Materials and MethodsThe multicenter, noninferiority, randomized‐controlled trial was conducted from May 2023 to March 2024. Treatment‐naive subjects were randomly assigned (1:1) to enter either the tegoprazan–amoxicillin (TA) group (tegoprazan 50 mg twice daily and amoxicillin 750 mg four times daily) or the esomeprazole–amoxicillin (EA) group (esomeprazole 20 mg and amoxicillin 750 mg all four times daily), with a duration for 14 days. The primary outcome was eradication rate as determined by 13C‐urea breath test, including per‐protocol (PP) analysis and intention‐to‐treat (ITT) analysis. Secondary outcomes were adverse events and compliance.ResultsA total of 368 individuals were included in the randomization. The eradication rates in the EA group and the TA group were 84.2% and 85.8%, respectively, according to an ITT analysis (p = 0.77), and 88.5% and 88.2%, respectively, according to PP analysis (p = 1.00). The eradication rates for the TA group were not inferior to those of the EA group in both PP (p = 0.0023) and ITT analyses (p = 0.0009). There were no significant statistical differences in the incidence of adverse events and compliance between the two groups. The multivariate logistic regression analysis revealed that poor compliance increased the risk of eradication failure (p < 0.001).ConclusionsDual therapy containing tegoprazan is safe and effective to be considered as a clinical first‐line treatment option, but further optimization involving antimicrobial susceptibility testing and adjustments in dosage and frequency is warranted.Trial RegistrationClinicalTrials.gov ID: NCT05870683.